Evaluating Innovative Health Programs: Lessons for Health Policy

The Global Development Network’s (GDN) project “Evaluating Innovative Health Programs” (EIHP), funded by the Bill & Melinda Gates Foundation, seeks to inform policy on the effectiveness of health solutions that have the potential to improve health outcomes in developing countries. It evaluates the impact of nineteen programs from across developing and transition countries that focus on the health-related Millennium Development Goals (MDGs) of reducing child and maternal mortality, and halting and reversing the trend of communicable diseases such as HIV/AIDS, malaria and other diseases. The policy implications of the diverse set of interventions are distinguished between programs that involved earmarking resources, changing incentives, and developing innovative methods of health care delivery.Millennium Development Goals; child and maternal health; communicable diseases; impact evaluation; capacity building; Asia; Africa; Latin America

Methods for Evaluating Innovative Health Programs (EIHP): A Multi-Country Study

Designed as a global research initiative, the EIHP project aims at adding to the evidence base of health interventions that have the potential to improve health outcomes in Africa and Asia. The project focuses on rigorous, quantitative evaluations of innovative local initiatives that address the Millennium Development Goals for health: reductions in child and maternal mortality and communicable diseases. This overview brings together the outcomes and lessons from the project for evaluation methods. It draws together the methodological implications of carrying out impact evaluations under very different settings and emphasizes the need to build in evaluations in project designs.Millennium Development Goals; child and maternal health; communicable diseases; impact evaluation; capacity building; Asia; Africa; Latin America

Richer, wiser and in better health? The socioeconomic gradient in hypertension prevalence, unawareness and control in South Africa

The socioeconomic gradient in chronic conditions is clear in the poorest and wealthiest of countries, but extant evidence on this relationship in low- and middle-income countries is inconclusive. We use data gathered between 2008 and 2012 from a nationally representative sample of over 10,000 South African adults, and objective health measures to analyse the differential effects of education, income and other factors on the prevalence of hypertension, individuals' awareness and control of hypertensive status. Prevalence of hypertension is high at 38% among women and 34% among men. 59% of hypertensive individuals are unaware of their status. We find prevalence and unawareness of hypertension are a public health concern across all income groups in South Africa. Higher income is however associated with effective control amongst men. Completing secondary education is associated with 7 mmHg lower blood pressure only in a small sub-group of women but is associated with 22 percentage point higher likelihood of effective hypertension control amongst women. We conclude that poorer and less educated individuals are particularly at high risk of cardiovascular disease in South Africa

Working Toward Beloved Community: Contemplative Practice and Social Justice In One Public University

This paper offers a descriptive case study of the ways a group of faculty, staff, and students introduced contemplative practices into a medium-sized state university community, with the long-term goal of fostering justice and inclusion for all members of that community. Using documents and oral and written narratives from key participants, we detail the ways community has been fostered through shared contemplative practices; faculty learning communities (FLCs) focused on contemplative pedagogy, compassion, and social justice; and the use of contemplative practices to underpin and guide decision-making. Evaluations from students and faculty members involved in these initiatives suggest that the use of contemplative practices not only serves to create connection and belonging but also is laying the foundation for spaces where the hard work of creating inclusion and justice can happen. Though our work is still very much in progress, we document and share our experiences in the hope that they can be helpful to others interested in working towards more just and inclusive academic institutions

Essays on ex ante evaluations of cash transfer programs

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Relationships between changes in HIV risk perception and condom use in East Zimbabwe 2003-2013: population-based longitudinal analyses

Background: Perceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception. Methods: Data on sexually active, HIV-negative adults (15-54 years) were taken from four surveys of a general-population open-cohort study in Manicaland, Zimbabwe (2003-2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bi-directional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated. Results: One thousand, nine hundred eighty-eight males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 0.85-2.28, PAF = 3.39%; females: aOR = 1.41 [1.06-1.88], PAF = 6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR = 1.76 [1.12-2.78]; females: aOR = 1.23 [0.93-1.62]) compared to those without change in risk perception. Conclusions: Results on associations between changing risk perception and increasing condom use support hypothesised effects of risk perception on condom use and effects of condom use on risk perception (down-adjusting risk perception after adopting condom use). However, low proportions of change in condom use were attributable to changing risk perception, underlining the range of factors influencing HIV prevention behaviour and the need for comprehensive approaches to HIV prevention

Wellbeing Over 50: A Capabilities Approach

Drawing on the three key relations in the capabilities approach (Sen, 1985) to welfare economics and using panel data from the English Longitudinal Survey of Aging, this paper illustrates how the capabilities approach to welfare economics can be used to understand wellbeing in older age. Specifically, we estimate models of variables related to all three aspects of a person's wellbeing: functionings, happiness and capabilities. Results indicate that the production of activities depends significantly inter alia on education, health and gender; that happiness depends on a wide variety of activities and that there are potentially significant gender inequalities in the constraints facing women compared with men. The paper concludes that the capabilities approach is a workable approach to empirical welfare economics, applicable to older age, and can generate a range of insights about welfare outcomes and their distribution

Allocation rules for global donors

In recent years, donors such as the Bill and Melinda Gates Foundation have made an enormous contribution to the reduction of the global burden of disease. It has been argued that such donors should prioritise interventions based on their cost-effectiveness, that is to say, the ratio of costs to benefits. Against this, we argue that the donor should fund not the most cost-effective interventions, but rather interventions which are just cost-ineffective for the country, thus encouraging the country to contribute its own domestic resources to the fight against disease. We demonstrate that our proposed algorithm can be justified within the context of a model of the problem as a leader-follower game, in which a donor chooses to subsidise interventions which are implemented by a country. We argue that the decision rule we propose provides a basis for the allocation of aid money which is efficient, fair and sustainable

Do risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting?

Young people in sub-Saharan Africa are particularly at high risk of sexually transmitted infections. Little is known about their preferences and even less about their association with risky sexual behaviour. We conducted incentivized economic experiments to measure risk, time and prosocial preferences in Zimbabwe. Preferences measured at baseline predict biomarker and self-reported measures of risky sexual behaviour gathered 12 months later. We find robust evidence that individuals more altruistic at baseline are more likely to be Herpes Simplex Virus Type-2 (HSV-2) positive 12 months later. Analysis by sex shows this association is driven by our sample of women. Having more sexual partners is associated with greater risk tolerance amongst men and greater impatience amongst women. Results highlight heterogeneity in the association between preferences and risky sexual behaviour

Evaluating Innovative Health Programs: Lessons for Health Policy

The Global Development Network’s (GDN) project “Evaluating Innovative Health Programs” (EIHP), funded by the Bill & Melinda Gates Foundation, seeks to inform policy on the effectiveness of health solutions that have the potential to improve health outcomes in developing countries. It evaluates the impact of nineteen programs from across developing and transition countries that focus on the health-related Millennium Development Goals (MDGs) of reducing child and maternal mortality, and halting and reversing the trend of communicable diseases such as HIV/AIDS, malaria and other diseases. The policy implications of the diverse set of interventions are distinguished between programs that involved earmarking resources, changing incentives, and developing innovative methods of health care delivery